DR. DENNIS HARTLIEB
Considerations for prosthetic replacement of the congenitally missing lateral incisor
Matching Composite to Porcelain
Minimally invasive dentistry. We hear the term all the time – but what does it mean. To each of us, it probably means something a little bit different. There are many examples of techniques to do minimally invasive dentistry, from ‘prepless’ veneers to ‘prep-less’ veneers. These are porcelain techniques that are populated by many dentists and dental laboratories to solve esthetic issues for our patients. Unfortunately, a lot of these ‘prepless’ cases look over contoured, or too bulky when placed, resulting in poor esthetics and soft tissue challenges. This bulk is especially notable at the cervical and gingival embrasures because if the porcelain is made too thin, the porcelain will fracture during try-in or delivery.
So then, understanding the limitations of porcelain in no-prep, or minimal prep cases, it should be clear that the best material that we have in our armamentarium for minimally invasive dentistry is direct composite, not porcelain. With direct resin, most often there is no tooth preparation at all! Simply clean the tooth (pumice or air abrasion), place and light cure your adhesive, and off you go. We get to use the natural undercuts from tooth contour to our advantage. But, unfortunately, I have found through my 25 years of teaching dentists and dental students, one of the biggest challenges for restorative dentists is placing naturally looking composite restorations. When is this especially challenging you may ask? When we are trying to blend our composite with porcelain restorations.
A common issue that I find in cosmetic dentistry is when I am replacing an old defective crown or restoring a single anterior tooth that has a large defective restoration, there is commonly a tooth proportion issue going on. So often, if I do some minimal bonding on other teeth in the esthetic zone, the single crown or veneer will become more seamless into the smile. This can be a simple mesial diastema closure on a lateral incisor (typically without tooth preparation at all) so that I can create symmetry with the central incisors, rather than extending the distal of the central crown to close the space entirely. Another perfect opportunity to use composite to blend with porcelain is when restoring peg lateral incisors. If you use porcelain to restore peg laterals, you will often note that the canines are unusually narrow, or they are very pointy with exaggerated incisal embrasures. Typically, the ceramist will overextend the distal-mesial dimension of the porcelain restoration to close the spaces, creating a wide, fat looking lateral incisor. Instead, I use composite, again without preparing the tooth, to add contour and tooth form to the canines, so the lateral incisors can have natural shape and form, creating a beautiful and balanced overall smile.
Ok, so we’ve talked about a couple of situations that are ideal for ‘no-preparation’ composite restorations. But how do we time the treatment? Do we do the bonding first, then take an impression for the porcelain restoration? Or do we place the porcelain restoration and then do our bonding? There are advantages to either situation – if I place the composite first, it can be helpful for the ceramist to create the properly sized restoration. However, sometimes it is easier for the ceramist to determine the ideal size restoration (i.e., single central incisor matching the other central incisor). So, if I think it would be easier for the ceramist to create the ideal tooth form and size, I will have them fabricate the porcelain restoration first. The downside of having the porcelain created first, is that it may be a little more challenging for us to create ideal contour and contact with the composite restoration.
Ok, so we’ve talked about a couple of situations that are ideal for ‘no-preparation’ composite restorations. But how do we time the treatment? Do we do the bonding first, then take an impression for the porcelain restoration? Or do we place the porcelain restoration and then do our bonding? There are advantages to either situation – if I place the composite first, it can be helpful for the ceramist to create the properly sized restoration. However, sometimes it is easier for the ceramist to determine the ideal size restoration (i.e., single central incisor matching the other central incisor). So, if I think it would be easier for the ceramist to create the ideal tooth form and size, I will have them fabricate the porcelain restoration first. The downside of having the porcelain created first, is that it may be a little more challenging for us to create ideal contour and contact with the composite restoration.
So then, understanding the limitations of porcelain in no-prep, or minimal prep cases, it should be clear that the best material that we have in our armamentarium for minimally invasive dentistry is direct composite, not porcelain. With direct resin, most often there is no tooth preparation at all! Simply clean the tooth (pumice or air abrasion), place and light cure your adhesive, and off you go. We get to use the natural undercuts from tooth contour to our advantage. But, unfortunately, I have found through my 25 years of teaching dentists and dental students, one of the biggest challenges for restorative dentists is placing naturally looking composite restorations. When is this especially challenging you may ask? When we are trying to blend our composite with porcelain restorations.
A common issue that I find in cosmetic dentistry is when I am replacing an old defective crown or restoring a single anterior tooth that has a large defective restoration, there is commonly a tooth proportion issue going on. So often, if I do some minimal bonding on other teeth in the esthetic zone, the single crown or veneer will become more seamless into the smile. This can be a simple mesial diastema closure on a lateral incisor (typically without tooth preparation at all) so that I can create symmetry with the central incisors, rather than extending the distal of the central crown to close the space entirely. Another perfect opportunity to use composite to blend with porcelain is when restoring peg lateral incisors. If you use porcelain to restore peg laterals, you will often note that the canines are unusually narrow, or they are very pointy with exaggerated incisal embrasures. Typically, the ceramist will overextend the distal-mesial dimension of the porcelain restoration to close the spaces, creating a wide, fat looking lateral incisor. Instead, I use composite, again without preparing the tooth, to add contour and tooth form to the canines, so the lateral incisors can have natural shape and form, creating a beautiful and balanced overall smile.
Ok, so we’ve talked about a couple of situations that are ideal for ‘no-preparation’ composite restorations. But how do we time the treatment? Do we do the bonding first, then take an impression for the porcelain restoration? Or do we place the porcelain restoration and then do our bonding? There are advantages to either situation – if I place the composite first, it can be helpful for the ceramist to create the properly sized restoration. However, sometimes it is easier for the ceramist to determine the ideal size restoration (i.e., single central incisor matching the other central incisor). So, if I think it would be easier for the ceramist to create the ideal tooth form and size, I will have them fabricate the porcelain restoration first. The downside of having the porcelain created first, is that it may be a little more challenging for us to create ideal contour and contact with the composite restoration.
Ok, so we’ve talked about a couple of situations that are ideal for ‘no-preparation’ composite restorations. But how do we time the treatment? Do we do the bonding first, then take an impression for the porcelain restoration? Or do we place the porcelain restoration and then do our bonding? There are advantages to either situation – if I place the composite first, it can be helpful for the ceramist to create the properly sized restoration. However, sometimes it is easier for the ceramist to determine the ideal size restoration (i.e., single central incisor matching the other central incisor). So, if I think it would be easier for the ceramist to create the ideal tooth form and size, I will have them fabricate the porcelain restoration first. The downside of having the porcelain created first, is that it may be a little more challenging for us to create ideal contour and contact with the composite restoration.
Related course: Digital Dental Photography
When it comes to matching the porcelain restoration, there are a few things that I look at:
1. Value, or brightness of the porcelain
2. The amount of incisal translucency built into the porcelain
3. The surface texture of the porcelain
Read also: Porcelain Margin Repair
Those are the 3 big issues for me: value, incisal translucency, and surface texture. The layering of composites that I use then are dependent on the aesthetics that I am trying to match. Well actually, I don’t tell patients that we are going to match the bonding to the porcelain – I tell them that I am going to ‘blend’ the composite with the porcelain. This helps to keep the patient’s expectations in check. Utilizing composites, opaquers and tints in proper layers are critical to create variation in translucency for natural esthetics.
The final issue though that is critical to help your composite bonding material blend with your porcelain restoration is choosing the appropriate composite. If you are looking to have the same polish of your composite as the porcelain that you are matching, especially long term, then you must use a microfill composite as the final surface material. Microfill composites polish better than hybrids and nanofills, and they maintain their polish long term. My favorite microfill is from Cosmedent – it’s in their Renamel system.
The final issue though that is critical to help your composite bonding material blend with your porcelain restoration is choosing the appropriate composite. If you are looking to have the same polish of your composite as the porcelain that you are matching, especially long term, then you must use a microfill composite as the final surface material. Microfill composites polish better than hybrids and nanofills, and they maintain their polish long term. My favorite microfill is from Cosmedent – it’s in their Renamel system.
Yours for better dental health,
The final issue though that is critical to help your composite bonding material blend with your porcelain restoration is choosing the appropriate composite. If you are looking to have the same polish of your composite as the porcelain that you are matching, especially long term, then you must use a microfill composite as the final surface material. Microfill composites polish better than hybrids and nanofills, and they maintain their polish long term. My favorite microfill is from Cosmedent – it’s in their Renamel system.
The final issue though that is critical to help your composite bonding material blend with your porcelain restoration is choosing the appropriate composite. If you are looking to have the same polish of your composite as the porcelain that you are matching, especially long term, then you must use a microfill composite as the final surface material. Microfill composites polish better than hybrids and nanofills, and they maintain their polish long term. My favorite microfill is from Cosmedent – it’s in their Renamel system.
Yours for better dental health,
Dennis Hartlieb, DDS, AAACD
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Meet Dr. Dennis Hartlieb
Dr. Dennis Hartlieb owns his own practice in Chicago,IL and has been teaching dentistry for over 30 years. Dr. Hartlieb is the CEO and the main instructor at Dental Online Training. He is an active member in the American Academy of Cosmetic Dentistry where he’s both an Accredited Member and Examiner for Accreditation.
Dr. Hartlieb is also the President of the Chicago Academy of Interdisciplinary Dentofacial Therapy, and a member of the prestigious American Academy of Restorative Dentistry.
Dr. Hartlieb is also the President of the Chicago Academy of Interdisciplinary Dentofacial Therapy, and a member of the prestigious American Academy of Restorative Dentistry.
Meet Dr. Angela Luek
Dr. Angela M. Lueck is a Wisconsin native and was the youngest female in her class from Marquette University in 1998. Since completing her residency she has consistently taken more than 100 hours a year of continuing education to keep current on the latest trends, techniques, and materials available in dentistry.
She volunteers her time to teach at Marquette University providing the students additional training with anterior and posterior bonding techniques as well as dental photography. She is also the co-chair of the mentorship program at the University. Dr. Lueck has been voted as one of Milwaukee’s top dentists multiple times by Milwaukee Magazine.
She volunteers her time to teach at Marquette University providing the students additional training with anterior and posterior bonding techniques as well as dental photography. She is also the co-chair of the mentorship program at the University. Dr. Lueck has been voted as one of Milwaukee’s top dentists multiple times by Milwaukee Magazine.
Meet Clare O'Neill
Clare O’Neill is the Director of Operations at Dental Online Training and has a professional background in digital marketing. Clare has certifications in content marketing and digital advertising. Clare has expertise in social media marketing, email marketing, content marketing, website management, and project management. Clare has been using Canva for over 5 years and is a self-proclaimed Canva Queen.
Clare graduated from Georgia State University with a Bachelor’s degree is Sociology. Clare wanted you to know that she is a dog person, loves the colors emerald green and periwinkle, and would eat french fries at every meal if she could!
Clare graduated from Georgia State University with a Bachelor’s degree is Sociology. Clare wanted you to know that she is a dog person, loves the colors emerald green and periwinkle, and would eat french fries at every meal if she could!
Meet Dr. Jim Mckee
Dr. McKee is a member of the Spear Resident Faculty. He has maintained a private practice since 1984 in Downers Grove, Illinois where he treats a wide variety of cases with a focus on predictable restorative dentistry. He is a member of the American Academy of Restorative Dentistry and former president of the American Equilibration Society.
He has lectured both nationally and internationally for over 25 years and directs several study clubs. Dr. McKee graduated from the University of Notre Dame in 1980 and earned his dental degree from the University of Illinois College of Dentistry in 1984.
He has lectured both nationally and internationally for over 25 years and directs several study clubs. Dr. McKee graduated from the University of Notre Dame in 1980 and earned his dental degree from the University of Illinois College of Dentistry in 1984.
Meet Kirk Behrendt
Kirk Behrendt is a renowned consultant and speaker in the dental industry, known for his expertise in helping dentists create better practices and better lives.
With over 25 years of experience in the field, Kirk has dedicated his professional life to optimizing the best systems and practices in dentistry.
Kirk Behrendt is the founder of ACT Dental, and his vision is driven by the commitment to provide highly personalized care to the dental profession. By creating a talented team of experts, Kirk and his team continue to positively impact the practice of dentistry on practice at a time. Kirk lectures all over the world to help individuals take control of their own lives.
With over 25 years of experience in the field, Kirk has dedicated his professional life to optimizing the best systems and practices in dentistry.
Kirk Behrendt is the founder of ACT Dental, and his vision is driven by the commitment to provide highly personalized care to the dental profession. By creating a talented team of experts, Kirk and his team continue to positively impact the practice of dentistry on practice at a time. Kirk lectures all over the world to help individuals take control of their own lives.
Meet Dr. Melissa Seibert
Melissa Seibert is a comprehensive dentist proudly serving in the Air Force. She holds a dual faculty appointment at Uniformed Services University and Creighton Dental School. She serves on the editorial board for Inside Dentistry.
Her current research projects involve investigating ceramic overlays, zirconia and salivary contamination of universal adhesives. Dr. Seibert is the creator and host of the top dental podcast, Dental Digest. She lectures to national and international audiences.
Her current research projects involve investigating ceramic overlays, zirconia and salivary contamination of universal adhesives. Dr. Seibert is the creator and host of the top dental podcast, Dental Digest. She lectures to national and international audiences.
Meet Olivia Wisden
Olivia Wisden is the founder & CEO of TwoLips Creative. What started as an events discovery app pivoted into a creative agency that specializes in working with startups, small businesses, and organizations who are looking for bold, impactful designs and strategies.
She has worked with dozens of brands over the years ranging from the City of Madison to product launches and beyond.
She has worked with dozens of brands over the years ranging from the City of Madison to product launches and beyond.
Meet Dr. Sofya Kats
Dr. Sofya Kats is local to Milwaukee, WI. She grew up in Bayside and attended Nicolet HS, UW-Milwaukee and Marquette University School of Dentistry. Dr. Kats is a member of the Greater Milwaukee Dental Association, Wisconsin Dental Association, American Dental Association, and The Forum Study Club (oldest Dental Study Club in the United States).
Dr. Kats loves the art of dentistry, and healing it can bring to her patients. She volunteers her time by going on international dental mission trips and local events, such as the Mission of Mercy (free dental care sponsored by the Wisconsin Dental Association).
Dr. Kats loves the art of dentistry, and healing it can bring to her patients. She volunteers her time by going on international dental mission trips and local events, such as the Mission of Mercy (free dental care sponsored by the Wisconsin Dental Association).